Healthcare Provider Details

I. General information

NPI: 1538161583
Provider Name (Legal Business Name): JOSEPH F FOWLER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 2ND ST
LOUISVILLE KY
40202-2862
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-7546
  • Fax: 502-589-3429
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-682-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1030824
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number21622
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: